EHHOP Mammography Guidelines
Women ages 40 to 49 are not routinely screened by imaging unless they are known to be of high risk.
If the patient has concerns, has a past history or other risk factors based on the Gail Model, screening mammogram will be discussed.Women 50 years and older should receive screening mammograms every two years. Screening can continue indefinitely as long as the woman remains in good health.
You may ask: "but, these don't look like the recommendations I'm familiar with?" That is because The American College of Radiology recommends annual screening at 40 for all women. Meanwhile, the USPSTF recommends starting at 50 and with only bi-annual screening. Additionally, there are 5 other organizations with different recommendations recognized by the CDC that cover everything in between. So there is no consensus. At EHHOP, we decided this was a reasonable in-between (especially given that we are working in a low-resource setting). However, feel free to allow patients to direct their care if they have preferences within the realm of acceptable guidelines.
Women at moderately increased risk
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Women at a moderately increased risk (15-20% over a lifetime) of developing breast cancer should discuss the benefits and limitations of adding an MRI to her biennial mammograms with their physicians. A woman has a moderately increased risk of developing breast cancer if she:
- Has a calculated 15-20% lifetime risk based on risk assessment tools
- Has a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobar carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or typical lobular hyperplasia (TLH)
- Has extremely dense breasts or unevenly dense breasts when viewed by mammogram
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In addition, women at moderately increased or increased risk of breast cancer should be advised on potential lifestyle modifications that may reduce the likelihood of developing cancer. These include:
- Smoking cessation
- Avoidance or limited use of hormone-replacement therapies for symptomatic menopause
- Increasing physical activity
Women at high risk
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Women at high risk (20% or greater over a lifetime) of developing cancer should receive an MRI in addition to a screening mammography. EHHOP will make efforts to connect women at high risk because of a genetic mutation or genetic syndrome with genetic counselors. A woman is considered at high risk of developing breast cancer if she:
- Is positive for the BRCA1 or BRCA2 mutation2
- Has a calculated 20% lifetime risk based on risk assessment tools
- Has a history of radiation therapy to the chest between the age of 10 and 30
- Has a genetic syndrome associated with increased risk of breast cancer, i.e. Li-Fraumeni, Cowden Syndrome, or Bannayan-Riley-Ruvalcaba syndrome or one of these syndromes in a first-degree relative
Full Guidelines
The full guidelines, including a preamble and sources, can be viewed here.